Case Report: Recurrent Respiratory Papillomatosis: A Report of two cases and review of literature

Abstract

Background: Recurrent Respiratory Papillomatosis (RRP) is a non-cancerous tumour of the upper airway caused by the human papilloma virus, presenting as “wart-like” growth, which could be anywhere from the nose to the lungs commonly in the larynx.
Design and Setting: Review of two cases at the National Hospital Abuja (NHA).
Objectives: To highlight the challenges in the management of RRP.
Subjects: Two patients diagnosed with RRP were referred to the paediatric respiratory clinic between 2009 and 2012. Case one is a four year old female who presented with persistent hoarseness of voice, breathing difficulty and noisy breathing of one year duration. She was born at term by spontaneous vertex delivery to a mother who had vaginal warty lesion excised during pregnancy. A neck X-ray showed opacities around the laryngeal region with total obliteration of air column with histological confirmation of squamous papilloma. She had eight excision surgeries within a two years period with treatment with oral acyclovir, interferon, and methotrexate and tracheotomy tube in situ. Case two, a six year old female presented with persistent hoarseness of voice that progressed to loss of voice, noisy and difficulty in breathing, snoring and frequent arousal from sleep of 1½ years. Histology was diagnostic of laryngeal Papillomatosis and she had two excisions surgeries and treatment with oral acyclovir and tracheotomy tube in place.
Conclusion: RRP though a slow growing tumour, presently has no definitive cure. Excision surgeries provide temporal relief and antiviral agents adjuvant therapies. Prevention with vaccination is desirable.

Keyword: Recurrent respiratory Papillomatosis, Human papilloma virus.